Ischial (sitting bone) bursitis pain

What is ischial bursitis pain?

Ischial bursitis pain is pain on the part of the pelvic bone (ischial tuberosity) that we sit on. It is not to be confused with the coccyx which sits at the base of the spine. Ischial pain refers to pain from the pelvic bone sitting under the buttock muscles ( gluteals)

Ischial bursitis describes inflammation in the fluid filled sac which lies on the underside of the ischial tuberosity. It often arises as a result of overloading of the hamstring muscles due to increased or excessive activity or through prolonged sitting. Alternative causes are sports which involve rapid accelerations, kicking and extremes of hip movement such as dance as they place significant load through the hamstring tendons.

Common symptoms

Pain is felt directly over the ischial tuberosity in the lower buttock area. Some individuals may suffer some pain radiating down the hamstring muscles at the back of the thigh. Symptoms are aggravated by sitting which places direct pressure onto the sitting bones and also with activities involving stretching or contraction of the hamstring muscles such as climbing stairs, squatting or sports involving rapid accelerations and kicking movements.

How is ischial pain diagnosed?

Ischial pain can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature is often tenderness when palpating directly over the ischial tuberosity.

X-rays are not helpful but a scan may be useful in cases which do not settle after conservative treatments,particularly if a corticosteroid injection is being considered.

Corticosteroid injection therapy

For individuals who have trialled a course of appropriate exercises and modified activities, corticosteroid injections can be offered as the next line of treatment for individuals whose primary symptoms are assessed to be due to ischial bursa inflammation. You can read more about local corticosteroid injections here.

How is ischial pain treated?

In the majority of cases, ischial pain can be managed very effectively by adhering to the following routines. The most effective aspects are avoiding aggravating activities and prolonged sitting.

Modifying seating positions
This could be using a seat with better cushioning to alleviate pressure on the painful area. Specialist seat cushions are available if needed.

Ceasing aggravating sporting activities
This does not mean that you will have to stop cycling, running etc forever. However, the ischial bursa and/ or hamstring tendons may need 4-6 weeks of relative rest initially to settle symptoms while you work on strengthening the hip muscles (see below).

Regular exercises to strengthen the hip muscles and tendons:

3×10 repetitions 3-4x per week

3×10 repetitions 3-4x per week

3×10 repetitions 3-4x per week

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.